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July 10, 2020 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Local COVID-19 Update KFL&A: 

The local outbreak of COVID-19, largely related to infections acquired in nail salons, is under control. Our local epidemiology is consistent with the gradual improvement in the epidemic we are seeing across Canada and in Ontario. There have been no new cases in KFL&A region. The running total for the epidemic is now 105 cases in the KFL&A region (see update from KFL&A Public Health) (Table below).

There are 27 COVID-19 patients actively recovering in the community. There are no longer any inpatients with COVID-19 in KHSC. Over the past 3 days we have performed 1060 SARS-CoV-2 tests. There was only 1 positive test from the Kawartha area. Our test positivity rate in KFL&A continues to fall and is currently <0.4%.

However, we need to adhere to universal masking in KHSC and public masking in indoor spaces (at Queen’s University and in all places of business in our region). The virus is circulating in the community and maintaining physical distancing and hand washing (plus masking in indoor spaces) will remain important for some time to come required.

KHSC still has good capacity to deal with a potential COVID-19 surge, with adequate beds and ventilators on hand. We are however getting busier from non-COVID-19 care, with increases in Emergency Department volumes to near seasonal normal levels. Likewise our Medicine wards are getting busier and our Alternate Level of Care (ALC) person load has begun to increase (39 people), which limits our bed capacity. ALC means a person does not require hospitalization and should be in long-term care facilities or retirement homes and are temporarily in hospital (see prior blog on this issue-click here). Moreover, we are still required to retain a 10% bed reserve (for potential ramp ups should COVID-19 rear its ugly head again).

We continue to use only 2 entrances at KHSC and one at HDH to reduce risk of infection entering the facility. Your patience with this important infection prevention measure is appreciated!

This is overall good news and should allow us to continue our surgical ramp-up and resume our ambulatory care ramp up, as we continue efforts to provide better care of the 99.9% (click here for more on this).

chart listing stats for KFL&A COVID-19

New Version of Universal Masking Policy Starts Tuesday: 

photo of disposable masks

There will be a FAQ document distributed for KHSC staff on Monday re: an enhanced requirement for universal masking, which begins on Tuesday. MASKS WILL BE PROVIDED AT ALL KHSC ENTRY POINTS and they must be used (unless an exemption has been prospectively obtained). This policy begins on Tuesday.

All staff will be provided with a mask for “entry/exit” of KHSC. This mask must be worn to enter the building. It can be reused for a week (storing it in a paper bag when not in use-bag provided). For staff in non-clinical areas this is the only mask you need. However, for staff in clinical areas you need to pick up a new masks at the care desk in the clinic and on wards. Clinical staff will then switch back to wear their “entry/exit” masks when they leave the building. Occupational health will be reviewing requests for exemption but please wait until KHSC provides the criteria for possible exemptions before requesting one. When there is an exemption, it will usually mean that a face shield will be worn as an alternative (i.e. some form of facial PPE will still be required).

Leon's Centre testing facility is open for COVID-19 testing of community members (click here for details of hours). The wait time at Leon Centre is short (10 minutes).

list of recent COVID-19 exposure areas

Symptomatic KHSC staff: Should KHSC staff develop symptoms consistent with COVID-19, please contact occupational health and safety and they will tell you how to proceed (ext 4389 at KGH site, or email COVIDrtwadjudication@kingstonhsc.ca). You will likely be tested at the Hotel Dieu testing centre. Do not come to work!

Kingston’s COVID-19 outbreak (click here) Our disease prevalence in the KFL&A region has risen to 49.4 cases/100,000 population. Toronto still has a rate >8 times higher (434.6 cases/100,000 population). The prevalence in Toronto has increased every day for the past month, reflecting neighbourhood hot spots.

Provincially the epidemic is in modest decline. There were 116 new cases yesterday (up 0.3% from yesterday). This is the lowest daily number of new cases since the epidemic began. Ontario has had a total of and 36,464 total cases and 2710 deaths to date. The 0.8% rate of positive SARS-CoV-2 tests yesterday was the lowest rate to date. The prevalence map for Ontario is shown below. All good news!

map of Ontario colour coding areas of COVID-19 prevalenceanimated photo of a flame

The prevalence of cases in Toronto is still increasing daily due to over a dozen neighbourhoods which are COVID-19 hotspots, defined as rates over 1000 case/100,000 (click here), including: Moss Park, Newton Brook West, Yorkdale Glen-Park, Downsview Roding CFB, Maple Leaf, Rexdale-Kipling, Black Creek, Mount Olive, Beechborough, York University Heights, Mount Dennis, Glenfield Jane Heights, and Weston. Humber Heights Westmount with 1763 cases/100,000 once again has the highest prevalence in Toronto. The ministry has deployed public health experts, mobile testing facilities and contact tracers to deal with these “epidemics within epidemics”.

map of cumulative COVID-19 rates by neighbourhood in Toronto

COVID-19 in Toronto

How’s Canada’s epidemic going? We have had 107,019 cases of COVID-19 in Canada and 8759 deaths (see below). As seen below, most cases are resolved (88%, green line, top below). The number of active cases per day has plateaued (orange line graphs, below). Quebec remains the hot spot with the majority of Canada’s active cases and over half of all cases in Canada to date 56,316/107,019). It is gratifying to see fewer deaths per day and fewer reported cases per day (bottom graphs below)

graph showing total cases and outcomes in  Canada

Canadian aggregate data 

The epicentre for COVID-19 mortality remains our long term care facilities (LTC) (see today’s data below). The ~78,000 residents of Ontario’s LTC facilities account for less than 0.5% of the population but they still account for 68% of all deaths from COVID-19! There have been 1833 deaths to date; but there were no deaths since yesterday in Ontario LTC centres. Canada had the highest rates of mortality in LTCs of any survey country. 81% of all COVID-19 deaths occurred in residents of LTCs (click here)! This is sad, embarrassing and requires rapid change in how we license, fund and monitor LTCs. 

Testing for SARS-CoV-2 (click here): We have tested 8.84% of all Canadians (3,358,238 people). As expected with increased testing of less symptomatic people the rate of test positivity is declining and nationally is 3.18% (vs 2.26% in Ontario). Ontario SARS-CoV-2 testing (see below) continues at a rate that exceeds the national average, with a rate of 11.3% (see below). 

graph showing testing vs positives in Ontario

The COVID-19 pandemic gone up by more than a million cases in the past week. There are now 12,323,502 cases globally and 556,110 deaths. The pandemic hot spots are in the Americas (Brazil and USA), Russia, and India (click here). These 4 countries account for half the world’s cases. 

America: I have children and many friends and colleagues in the United States and so I report the data below, once again, with great concern (click here). Note that the daily new cases are continuing to increase with no sign of a plateau, in the graphic below. Note the Canadian case incidence hugging the horizontal axis by comparison! The failure of leadership and mixed messaging (or incorrect messaging) regarding the value of nonpharmacological public health interventions in America, Brazil, Russia and India and failure of implementation of a national public health response to the pandemic has contributed to disease spread in these countries. These are concerning times for our friends, family and colleagues in America. The graph below shows cases/million population (linear plot, 7 day average). We will not be seeing the border opening in the near future.

Graph showing daily confirmed cases by country

Here is a little Friday levity: 

A visual reminder that the road to success is not always easy to identify!

18 wheeler crashed through a fence

But we should not worry, because..

photo of sinking boat called no worries

with great planning we can…

name of building not spelled correctly

Be happy and, in any case…

photo of elephant spraying water all over himself

TGIF!

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